<?php echo form_open('staffprofile/createstaffchecklist/'.$staffId,array('class'=>'form-horizontal','id'=>'frm'));?>
<fieldset>
    <legend><h4><?php echo $title;?></h4></legend>
    <div class="control-group">
	    <label class="control-label">Contract</label>
	    <div class="controls">
	       <input type="checkbox" name="Contract" />
	    </div>
  	</div>
    <div class="control-group">
	    <label class="control-label">Code Conduct</label>
	    <div class="controls">
	      <input type="checkbox" name="CodeConduct" />
	    </div>
  	</div>
  	 <div class="control-group">
	    <label class="control-label">Conflict Interest</label>
	    <div class="controls">
	      <input type="checkbox" name="ConflictInterest" />
	    </div>
  	</div>
  	 <div class="control-group">
	    <label class="control-label">IRMeeting</label>
	    <div class="controls">
	      <input type="checkbox" name="IRMeeting" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">SelfDecForm</label>
	    <div class="controls">
	      <input type="checkbox" name="SelfDecForm" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">PerInfoForm</label>
	    <div class="controls">
	      <input type="checkbox" name="PerInfoForm" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">Email</label>
	    <div class="controls">
	      <input type="checkbox" name="Email" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">Bank Account</label>
	    <div class="controls">
	       <input type="checkbox" name="BankAccount" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">Staff DisCard</label>
	    <div class="controls">
	       <input type="checkbox" name="StaffDisCard" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">SendBD</label>
	    <div class="controls">
	      <input type="checkbox" name="SendBD" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">StaffProfile</label>
	    <div class="controls">
	      <input type="checkbox" name="StaffProfile" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">Insurance State</label>
	    <div class="controls">
	       <input type="checkbox" name="InsuranceState" />
	    </div>
  	</div>
   	<div class="control-group">
	    <label class="control-label">Visa</label>
	    <div class="controls">
	       <input type="checkbox" name="Visa" />
	    </div>
  	</div>
    <div class="control-group">
	    <label class="control-label">Visa End Date</label>
	    <div class="controls">
	       <input type="text" name="VisaDate" class="datepicker" />
	    </div>
  	</div>
  	<div class="control-group">
	    <label class="control-label">Remark</label>
	    <div class="controls">
	       <textarea name="Remark" rows="3"></textarea>
	    </div>
	 </div>
    <?php echo $form; ?>
 </fieldset> 

<?php echo form_close();?>